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PRE-EVALUATION APPLICATION FORM (COMPULSORY)

Please read the explanation below before filling the form:

1. To fill this form is obligatory for all applicants.
2. Please be aware of filling the correct form for the master’s program you would like to attend.
3. In this form, there are two sections that you have to fill in.
First section is to understand whether your bachelor degree is competent for the master program you are applying to, while the
second section is to evaluate your previous experience in this field

NAME / E-MAIL ADDRESS:

SURNAME: SKYPE
ADDRESS:
Program to apply: MD Engineering and Management for Health

PART A: For the following Scientific Areas list the courses you attended in your career / Bachelor Degree
*Except the last column (Note), all the columns should be filled by the student. The last column will be filled by the Academic
Board.
ECTS Years Hours of
Courses /Disciplines Accomplished Credits of Study Note*
Major Areas of Study (if Study (per semester (To be filled by the Academic Board)
available) or per year )
1.
2.
Mathematics and
3.
Statistics 4.
5.

1.
2.
Physics and 3.
Chemistry 4.
5.
Engineering 1.
2.
and applied sciences
3.

UFFICIO PROGRAMMI INTERNAZIONALI

Via San Bernardino 72e
24122 Bergamo
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4.
5.

Medicine and 1.
Biomedical Engineering 2.
3.
4.
5.

PART B: Please list other training / extracurricular activities including non-university activities (Professional Trainings / Courses, Internships,
Certificates, Seminars, Jobs etc.)
*Except the last column, all the parts should be completed by the student.

Total
Hosting Dates Notes*
Description Number of
Organization Issued (To be completed by Academic Board)
Hours

UFFICIO PROGRAMMI INTERNAZIONALI

Via San Bernardino 72e
24122 Bergamo
noeu.preadmission@unibg.it